Dramatic increase in serum trypsinogens, SPINK1 and hCGβ in aortic surgery patients after hypothermic circulatory arrest

Abstract

The concentrations of several diagnostic markers have been found to increase dramatically in critically ill patients with a severe disturbance of normal physiological homeostasis, without indication of the diseases they are normally associated with. To prevent false diagnoses and inappropriate treatments of critically ill patients, it is important that the markers aiding the selection of second-line treatments are evaluated in such patients and not only in the healthy population and patients with diseases the markers are associated with. The levels of trypsinogen isoenzymes, the trypsin inhibitor serine peptidase inhibitor Kazal type 1 (SPINK1), hCG and hCGβ, which are used as pancreatitis and cancer markers, were analyzed by immunoassays from serum samples of 17 adult patients who have undergone surgery of the ascending aorta during hypothermic circulatory arrest (HCA) with optional selective cerebral perfusion. Highly elevated levels of trypsinogen-1, -2 and -3, SPINK1 and hCGβ were observed in patients after HCA. This was accompanied by increased concentrations of S100β and NSE. In conclusion, this study highlights the importance of critically evaluating the markers used for aiding selection of second line of treatments in critically ill patients.

Keywords:

• Hypothermic circulatory arrest
• aortic surgery
• biomarkers
• critical illness
• hCGβ
• SPINK1
• trypsin
• trypsinogen

Acknowledgments

The authors would like to thank Ms. Annikki Löfhjelm, Ms. Maarit Leinimaa and Ms. Taina Grönholm for excellent technical assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the grants from University of Helsinki, Helsinki University Hospital Special Funds, the Finnish Funding Agency for Technology and Innovation (TEKES), the Finnish Cancer Foundation, the Academy of Finland, Finnish Society of Clinical Chemistry, Sigrid Jusélius Foundation, Laboratoriolääketieteen edistämissäätiö and Finska Läkaresällskapet.